Clostridioides difficile
From IDWiki
Microbiology
- Spore-forming, anaerobic, Gram-positive bacillus
Severity
| Severity | Definition |
|---|---|
| Mild | WBC ≤15 AND creatinine ≤1.5 x baseline |
| Severe, uncomplicated | WBC >15 OR creatinine >1.5 x baseline OR hypoalbuminemia |
| Severe, complicated | Hypotension OR shock OR ileus OR megacolon |
Management
| Severity | First-line | Alternatives |
|---|---|---|
| Initial episode | ||
| Mild to moderate | Vancomycin 125 mg po QID for 10-14 days | Fidaxomicin 200 mg po BID for 10 days Metronidazole 500 mg po TID for 10-14 days |
| Severe, uncomplicated | Vancomycin 125 mg po QID for 10-14 days Fidaxomicin 200 mg po BID for 10 days |
|
| Severe, complicated | Vancomycin 125-500 mg po QID for 10-14 days plus metronidazole 500 mg IV q8h | Fidaxomicin 200 mg po BID for 10 days plus metronidazole 500 mg IV q8h Consider rectal vancomycin if ileus |
| Recurrent episode | ||
| First recurrence, mild to moderate | Vancomycin 125 mg po QID for 14 days | Fidaxomicin 200 mg po BID for 10 days |
| First recurrence, severe, uncomplicated | Vancomycin 125 mg po QID for 14 days Fidaxomicin 200 mg po BID for 10 days |
|
| Second or subsequent recurrence | Vancomycin as prolonged tapered or pulsed regimen | Consider fecal microbiota tranplantation after vancomycin |
- For rectal vancomycin, add 500 mg to 100 mL normal saline and give as retention enema every 6 hours
- A sample vancomycin taper: 125 mg po QID for 14 days, then 125 mg po TID for 7 days, then 125 mg po BID for 7 days, then 125 mg po daily for 7 days, then 125 mg po q2-3d for 2 to 8 weeks
Further Reading
- AMMI treatment practice guidelines for Clostridium difficile infection 2018
- Clostridioides difficile: diagnosis and treatments. BMJ. 2019;366:l4609. doi: 10.1136/bmj.l46091
